MANDATRACK OPT-OUT FORM

Name ______________________________________________ Username _________________

Address ____________________________________________ Date _____________________

Reason for Opting-Out from MandaTrack:

I am fully aware of the registration requirement and purpose of Mandaluyong City Ordinance No. 814, S-
2021 or the “MandaTrack Ordinance”. I hereby express my decision to opt-out from the MandaTrack
which will result in the erasure or deletion of my unique QR Code and personal information in the system.
My decision to opt-out is being made voluntarily without any force, coercion or intimidation.

_____________________________
(Signature over printed name)

PRIVACY STATEMENT: Any or all personal data you provided will only be used to process any your request
to opt-out from the MandaTrack. This includes contacting you should there be need for clarifications or additional
information. All collected data will be kept secure and confidential, unless otherwise authorized by law. They will
be disposed of as soon as the purpose for their use has been achieved. Only aggregate or anonymized data shall be
subject to further processing. We respect your rights under the Data Privacy Act. Should you wish to be clarified
on how we are processing of your personal data, or have questions or clarifications relative to privacy and data
protection, you may contact us at dpo@mandaluyong.gov.ph.